Surgical instrument control

ABSTRACT

A medical device can include a working end comprising a jaw mechanism configured to perform a clamping function and a translating cutting mechanism configured to perform a cutting function in response to translating movement of the translating cutting mechanism. The medical device can further include at least two user-actuated input mechanisms, and a computer processor operably coupled to the working end and to the at least two user-actuated control input mechanisms. In an operational state, the computer processor commands a movement of the translating cutting mechanism through a first range of motion in response to a first command received from actuation of a first of the at least two user-actuated control input mechanisms, and commands a movement of the translating cutting mechanism through a second range of motion in response to at least a second command received from actuation of at least a second of the at least two user-actuated control input mechanisms, the second range of motion being different from the first range of motion.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. application Ser. No.15/357,589, filed Nov. 21, 2016, which is a continuation of U.S.application Ser. No. 14/866,268, filed Sep. 25, 2015 (now U.S. Pat. No.9,504,517), which is a continuation of U.S. application Ser. No.13/834,760, filed Mar. 15, 2013 (now U.S. Pat. No. 9,144,456), whichclaims priority to U.S. Provisional Patent Application No. 61/621,974,filed on Apr. 9, 2012 (now expired), each of which is incorporatedherein by reference in its entirety.

TECHNICAL FIELD

Aspects of the present disclosure concern surgical instrument control,and more particularly concern safe control of a surgical instrumentcutting function.

INTRODUCTION

Certain hand-operated surgical tools use an I-beam shaped component toslide over and compress jaws together in order to provide a uniformcompressive force on tissue to be fused. As the component slides overthe jaws, the component's leading edge cuts tissue held between thejaws. An example of such a tool is a rounded tip Enseal® tissue sealerusing I-Blade® technology, as commercialized by Ethicon Endo-Surgery,Inc.

Since the same moving component is used to close the jaws, compress thetissue between the jaws, and cut the compressed tissue, it is possibleto inadvertently cut tissue while closing the jaws in a simple tissuegrasping operation, or to cut tissue ahead of a complete tissue fusing.To prevent such inadvertent cutting, a movable mechanical stop is usedto prevent the component from moving beyond its jaw closure function andinto its cutting function. If an operator fails to properly set themechanical stop, however, tissue grasped between the jaws may bepartially cut, either with or without the application of electrosurgicaltissue fusing energy. The result is that a patient is needlessly injured(e.g., tissue is inadvertently cut during grasping; tissue intended tobe fused is cut before fusing is complete, with resulting bleeding;etc.). In addition, during minimally invasive surgery, controllingbleeding that may result from such an inadvertent cutting or incompletefusing may be difficult and time consuming, exposing the patient tofurther risk. What is needed, therefore, is a way to take advantage ofthe benefits of the jaw closure, clamping, and cutting mechanism whilepreventing the risk of inadvertent cutting.

SUMMARY

The present teachings may solve one or more of the above-mentionedproblems and/or may demonstrate one or more of the above-mentioneddesirable features. Other features and/or advantages may become apparentfrom the description that follows.

In accordance with various exemplary embodiments, the present teachingscontemplate a computer-controlled surgical system that comprises asurgical instrument having a working end and a control system configuredto separately control a grasping function of the working end and acutting function of the working end. The control system can beoperatively connected to a first input device for controlling thegrasping function of the working end and can be operatively connected toa second input device for controlling the cutting function of theworking end.

In accordance with various exemplary embodiments, the present teachingscontemplate a method of controlling multiple functions of a working endof a computer-controlled surgical instrument. The method comprisescontrolling a clamping function of the working end of the instrument inresponse to input received from a first input device. The method furthercomprises separately controlling a cutting function of the working endof the instrument in response to input received from a second inputdevice.

Additional objects and advantages of the present teachings will be setforth in part in the description which follows, and in part will beobvious from the description, or may be learned by practice of thepresent disclosure and/or claims. At least some of those objects andadvantages of the present disclosure will be realized and attained bymeans of the elements and combinations particularly pointed out in theappended claims.

It is to be understood that both the foregoing general description andthe following detailed description are exemplary and explanatory onlyand are not restrictive of the present disclosure and claims, which areentitled to their full breadth of scope including equivalents.

BRIEF DESCRIPTION OF THE DRAWINGS

The present disclosure can be understood from the following detaileddescription, either alone or together with the accompanying drawings.The drawings are included to provide a further understanding of thepresent disclosure, and are incorporated in and constitute a part ofthis specification. The drawings illustrate one or more exemplaryembodiments of the present teachings and together with the descriptionserve to explain certain principles and operation. In the drawings:

FIGS. 1A to 1E are diagrammatic plan views of a jaw closure and tissuecutting mechanism in accordance with the present teachings;

FIG. 1F is a perspective cutaway view of an embodiment of the mechanismillustrated in FIGS. 1A to 1E in accordance with the present teachings;

FIG. 2 is a diagrammatic view of a computer-controlled surgical systemin accordance with the present teachings;

FIG. 3 is a diagram that illustrates an implementation of a process inaccordance with the present teachings;

FIG. 4 is a diagram that illustrates an implementation of an alternativeprocess, in accordance with the present teachings; and

FIG. 5 is a diagram that illustrates an implementation of anotheralternative process, in accordance with the present teachings.

DETAILED DESCRIPTION

This description and the accompanying drawings that illustrate exemplaryembodiments should not be taken as limiting, with the claims definingthe scope of the present disclosure. Various mechanical, compositional,structural, electrical, and operational changes may be made withoutdeparting from the scope of this description and the present teachingsas claimed, including equivalents. In some instances, well-knownstructures, and techniques have not been shown or described in detail soas not to obscure the disclosure. Like numbers in two or more figuresrepresent the same or similar elements. Furthermore, elements and theirassociated features that are described in detail with reference to oneembodiment may, whenever practical, be included in other embodiments inwhich they are not specifically shown or described. For example, if anelement is described in detail with reference to one embodiment and isnot described with reference to a second embodiment, the element maynevertheless be claimed as included in the second embodiment.

For the purposes of this specification and appended claims, unlessotherwise indicated, all numbers expressing quantities, percentages, orproportions, and other numerical values used in the specification andclaims, are to be understood as being modified in all instances by theterm “about,” to the extent they are not already so modified.Accordingly, unless indicated to the contrary, the numerical parametersset forth in the following specification and attached claims areapproximations that may vary depending upon the desired propertiessought to be obtained by the present teachings. At the very least, andnot as an attempt to limit the application of the doctrine ofequivalents to the scope of the claims, each numerical parameter shouldat least be construed in light of the number of reported significantdigits and by applying ordinary rounding techniques.

Notwithstanding that the numerical ranges and parameters setting forththe broad scope of the are approximations, the numerical values setforth in the specific examples are reported as precisely as possible.Any numerical value, however, inherently contains certain errorsnecessarily resulting from the standard deviation found in theirrespective testing measurements. Moreover, all ranges disclosed hereinare to be understood to encompass any and all subranges subsumedtherein.

It is noted that, as used in this specification and the appended claims,the singular forms “a,” “an,” and “the,” and any singular use of anyword, include plural referents unless expressly and unequivocallylimited to one referent. As used herein, the term “include” and itsgrammatical variants are intended to be non-limiting, such thatrecitation of items in a list is not to the exclusion of other likeitems that can be substituted or added to the listed items.

In accordance with various exemplary embodiments, the present disclosurecontemplates a surgical instrument, such as an electrosurgicalinstrument, that includes a shaft and a working end (end effector). Theworking end of the instrument includes components operable to performgripping, cutting, and fusing procedures. The surgical instrument may bea hand-operated surgical instrument or an instrument in a teleroboticsurgical system. The present disclosure contemplates that such asurgical instrument is operatively connected to a computer controlsystem that independently controls each of the gripping, cutting, andfusing procedures of the instrument based on separate inputs. Toinitiate a desired function, the operator must select the appropriateinput control function.

The present disclosure further contemplates that a single component ofthe working end of the instrument may be used to control both thegripping and cutting procedures through, for example, control of firstand second ranges of motion of the component. Control of the energyapplication for the fusing procedure may be through individuallyreceived inputs or via the system computer in response to a systeminput. The present disclosure further contemplates that two procedures,although independently controlled, may be initiated at the same time inan automated manner. For example, the cutting and energy applicationfunctions may be simultaneously started after tissue is grasped topermit substantially simultaneous fusing and cutting of the tissue in anautomatic process.

FIGS. 1A to 1E are diagrammatic plan views of a working end of asurgical instrument including a jaw closure and tissue cuttingmechanism. Details of such a mechanism are described in, for example,U.S. Pat. No. 6,905,497 B2, entitled “Jaw Structure for ElectrosurgicalInstrument” (filed May 31, 2003) and U.S. Patent Application Pub. No.2003/0114851 A1, entitled “Electrosurgical Jaws for ControlledApplication of Clamping Pressure” (filed Dec. 13, 2001), both of whichare incorporated herein by reference in their entirety. The followingdescription highlights features associated with the present teachings.It should be understood that aspects of the present disclosure may beimplemented with the various details shown in these two references(e.g., two movable jaws, one fixed and one movable jaw, jaws allowed tomove apart slightly near the jaw fulcrum, etc.). It should be furtherunderstood that although the description below is in the context of anelectrosurgical tool that fuses and cuts tissue, the same aspects may beapplied to other instruments that may use a similar jaw closure andcutting architecture, such as surgical staplers.

FIG. 1A shows a set of jaws 1 a and 1 b. Jaw 1 a (shown in phantom lineto more clearly illustrate operating features) is fixed in position withreference to the distal end of a surgical instrument shaft (not shown),and jaw 1 b pivots with reference to jaw 1 a at fulcrum 2 so that theinner faces 3 a,3 b of the jaws face each other when the jaws areclosed. Electrodes (FIG. 2) configured to receive electrosurgical energyfor tissue fusing are positioned on the jaws and in one implementationform a part of the inner faces 3 a, 3 b.

A reciprocating element 4 is movable relative to jaws 1 a, 1 b, betweena full proximal position (see FIG. 1A) and a full distal position (seeFIG. 1E). The reciprocating element 4 performs two functions. First, thereciprocating element 4 closes the jaws together. In the depictedimplementation, reciprocating element 4's cross section is I-shaped, sothat at least the distal part of reciprocating element 4 is shaped as anI-beam. As such, reciprocating element 4 includes a lower jaw closureflange 5 a, an upper jaw closure flange 5 b, and a connecting web 6 thatconnects the two flanges 5 a, 5 b. At the distal end of reciprocatingmember 4, upper jaw closure flange 5 b is extended to include twoshoulder elements 7 a and 7 b (hidden behind 7 a). These shoulderelements 7 a, 7 b include cam surfaces 8 a, 8 b that engage withcorresponding cam surfaces 9 a, 9 b on jaw 1 b.

It can be seen from FIG. 1A that as reciprocating element 4 moves in aproximal direction to a full proximal position, as indicated by thearrow, cam surfaces 8 a, 8 b engage with corresponding cam surfaces 9 a,9 b, which causes jaw 1 b to pivot around fulcrum 2 towards an openposition as shown. Similarly, as shown in FIG. 1B, as reciprocatingelement 4 moves in a distal direction towards the end tip of theinstrument, as shown by the arrow, cam surfaces 8 a, 8 b engage withcorresponding cam surfaces 9 a, 9 b to pivot jaw 1 b around fulcrum 2towards a closed position. In the closed position, a small gap 10 existsbetween jaw 1 a and jaw 1 b. Tissue to be fused and cut is held in gap10 between the two jaws 1 a, 1 b.

FIG. 1C shows that as reciprocating element 4 moves distally from theposition shown in FIG. 1B, a clamping force begins to be applied totissue between the jaws 1 a, 1 b. The clamping force is initially fromthe jaws being compressed between shoulder elements 7 a, 7 b and lowerjaw closure flange 5 a. At the near-proximal position illustrated inFIG. 1C, this clamping force is small. The clamping force becomesuniformly applied along the length of the jaws as the jaw closureflanges 5 a, 5 b move along the jaws, as shown in FIGS. 1D and 1E.

FIG. 1C also illustrates reciprocating element 4's second function,which is to cut tissue clamped between the jaws 1 a, 1 b. As shown, thedistal edge 11 of web 6 is a tissue cutting blade. Alternatively, edge11 represents an electrosurgical energy cutting element as described inmore detail in the references above. It can be seen that asreciprocating element 4 moves distally, blade 11 enters gap 10 and willcut any tissue securely held between jaws 1 a, 1 b. To preventinadvertent cutting, therefore, a mechanical stop 12 engages part 13 ofreciprocating element 4 to limit reciprocating element 4's distal traveland resultant tissue cutting. Alternatively, a similar mechanical stopmay engage another component that causes reciprocating element 4 tomove.

FIG. 1D shows that if stop 12 is moved away from engaging reciprocatingelement 4, then reciprocating element 4 may continue to move distally.Blade 11 enters gap 10 and cuts tissue grasped between jaws 1 a, 1 b. Atthe same time, upper and lower jaw closure flanges 5 a, 5 b begin toapply a high clamping force against the jaws and consequently againstthe tissue held between the jaws in gap 10.

FIG. 1E shows reciprocating element 4 at a full distal position, atwhich a high and uniform clamping force is applied to jaws 1 a and 1 b.At the position shown in FIG. 1E, blade 11 has cut any tissue in gap 10,and the necessary high clamping force has been applied to the tissue ingap 10 to enable an application of electrosurgical energy for successfultissue fusing.

It can be seen that reciprocating element 4 is representative of similarimplementations in other devices. For example, it is known that linearsurgical staplers use a sled that translates along a staple cartridge toforce staples through tissue for formation against an anvil, which istypically a jaw similar in concept to jaw 1 b. A tissue cutter, such asa knife blade, is fixed to the sled and cuts tissue clamped between thestaple cartridge and anvil in a manner similar in concept to blade 11.If a portion of the reciprocating element is configured to bend (e.g.,in a single degree of freedom orthogonal to the plane of jaw closure),then the surgical tool can be implemented with a distal end wristcapability to facilitate maneuverability inside the body, such as duringminimally invasive surgery (e.g., laparoscopic or thoracoscopicsurgery). Wrist aspects are discussed in more detail below.Alternatively, a portion of the reciprocating element may be allowed toflex with a more gradual bend, so that the shaft between an actuator andthe surgical end effector may be made flexible.

FIG. 1F is a perspective cutaway view of an embodiment of the surgicalinstrument working end mechanism illustrated in FIGS. 1A to 1E. FIG. 1Fshows an exemplary embodiment in which cam surfaces 8 a and 9 a interactto open and close the jaws 1 a, 1 b. FIG. 1F also shows how lower andupper jaw closure rails 5 a, 5 b slide along the jaws 1 a, 1 b to clampthe jaws together. Finally, FIG. 1F shows that web 6 slides through slot14 a in jaw 1 a and slot 14 b in jaw 1 b as reciprocating element 4moves distally. Thus tissue cut by blade 11 (hidden from view) at thedistal end of web 6 remains clamped between the two jaws 1 a, 1 b.

FIG. 2 is a diagrammatic view of an exemplary embodiment of acomputer-controlled surgical system 100 in accordance with an aspect ofthe present disclosure. In one implementation, surgical system 100 is ageneral purpose telerobotic surgical system, such as the da Vinci® Si™Surgical System commercialized by Intuitive Surgical, Inc., Sunnyvale,Calif. In another implementation, surgical system 100 is a hand-heldtool similar to current hand-held electrosurgical or stapling tools,such as the powered iDrive™ stapler commercialized by Covidien AG andthe hand-actuated EnSeal® tissue sealing devices commercialized byEthicon Endo-Surgery, Inc. Persons familiar with robotic and medicaldevice engineering will understand many of the routine mechanical andmedical device implementation details, which are omitted from thisdescription to avoid prolix explanation.

Surgical system 100 includes a computer control system 101 that controlssystem 100 operations in whole or in part. Computer control meanscontrol by any device that performs computations to effect such control,and it includes, by way of non-limiting example, control using amicroprocessor, a microcontroller, a digital signal processor, a fieldprogrammable gate array, a programmable logic device, an opticalcomputer, or any other form of programmable control that performscomputations. Shared control occurs when part of the control is done bycomputer control, and part of the control is done by other means, suchas manual operation. Control system 101 is configured to carry out oneor more of the various implementations described herein.

Actuator 102 (e.g., a telerobotic slave servo actuator, an electricmotor in a hand held tool, and the like) is coupled to and controlled bycontrol system 101. In turn, reciprocating element 4 is coupled toactuator 102 via transmission mechanism 103, so that actuator movesreciprocating element 4 proximally and distally as described herein.Transmission mechanism 103 may include various mechanical devices suchas levers, cams, gears, or lead screws in order to transmit actuationforce and/or torque from actuator 102 to reciprocating element 4. Anexample of shared control is if movement of reciprocating element 4 iscontrolled over one range of travel as a result of computer control, andcontrolled over a second range of travel as a result of manual control(the actuator 102 being, in effect, two separate actuating components,the one back driving the other and any of the other's relevantassociated transmission mechanism components).

In one optional implementation, reciprocating element 4 is coupled totransmission mechanism 103 via a wrist 104. Transmitting force and/ortorque through a wrist mechanism or flexible shaft, as described above,is known to persons familiar with robotics and powered medical devicedesign. For example, a bendable band may be pushed and pulled through asingle degree of freedom (DOF) wrist, a cable (e.g., a Bowden cable orthe like) may be pushed and pulled through a two-DOF wrist, and aflexible torque tube may be used to transmit torque through a one- ortwo-DOF wrist. Exemplary structures and methods for transmitting forceand/or torque through a wrist are described, for example, in U.S. PatentApplication Publication No. 2012/0215220, entitled “Fusing and CuttingSurgical Instrument and Related Methods” (filed Feb. 17, 2012); U.S.Pat. No. 7,303,107 B2, entitled “Surgical Stapling Apparatus” (filedJul. 19, 2006); U.S. Pat. No. 7,784,662 B2, entitled “SurgicalInstrument with articulating shaft with a single pivot closure anddouble pivot frame ground” (filed Apr. 7, 2005); and U.S. Pat. No.7,861,906 B2, entitled “Surgical stapling apparatus with articulatablecomponents” (filed Feb. 14, 2008), all of which are incorporated hereinby reference in their entireties.

As shown in FIG. 2, computer control system 101 receives at least twoinputs 105 a, 105 b that result in motion of reciprocating element 4.For example, in one exemplary implementation a first input 105 a, is apincer type grip master control that when activated moves reciprocatingelement 4 slave to open and close jaws 1 a and 1 b as described abovewith reference to FIGS. 1A to 1C. Computer control system 101 preventsany input from first input 105 a from commanding actuator 102 to movereciprocating element 4 to a position distal from the position shown inFIG. 1C, so that operator control via first input 105 a will not resultin inadvertent cutting of tissue between jaws 1 a, 1 b. This feature isa key safety aspect, since with purely mechanical implementations if thereciprocating element mechanical limit stop 12 is mistakenly out ofposition, tissue may be cut when only grasping between jaws 1 a, 1 b isintended.

Therefore, in accordance with an aspect of the present disclosure, theuser activates second input 105 b in order to move reciprocating element4 into gap 10 and cut tissue, as illustrated in FIGS. 1D and 1E. Secondinput 105 b is, for example, a foot pedal. In some implementations, anoptional third input 105 c is included in system 100. Details concerningvarious input device configurations (e.g., inputs 105) are describedbelow.

FIG. 2 also shows an Electrosurgical Unit (ESU) 106 coupled toelectrodes 107 on jaws 1 a, 1 b. In some implementations, as shown, ESU106 is coupled to computer control system 101 so that ESU 106 receivescommands via inputs 105 a, 105 b, and optionally 105 c, to introduceelectrosurgical energy to electrodes 107. In other implementations, ESU106 and electrodes 107 are separate from system 100, and inputs receivedfor computer control system 101 have no control over ESU 106. In suchimplementations, one or more separate ESU inputs 108 (e.g., foot pedalcontrol) are used to operate ESU 106. Thus, ESU 106 can be controlledeither from its individual control input or via the system computer(computer control system 101) in response to a system input.

FIG. 3 is a diagram that illustrates an implementation of a process inaccordance with an aspect of the present disclosure. Six conditions areshown from top to bottom: jaw position control, reciprocating element(beam) position, jaw position, jaw clamp force, energy applicationcontrol, and energy application. This process, and the ones illustratedin FIGS. 4 and 5, along with the variations described herein, can beimplemented in various systems ranging, for example, from large, generalpurpose, computer-controlled teleoperated surgical robots to hand-held,single purpose, computer-controlled surgical tools. As this process isdescribed, various alternative implementations are also described.

At t1 an operator begins to operate a jaw position control (e.g., firstinput 105 a). This control is typically operated by one or more digitsof the hand as an emulation of control of a purely hand-operatedinstrument, such as a small forceps. For example, in one surgicalrobotic system, the jaw position is controlled by the operator squeezingpincer elements together with two digits. Alternatively, adigit-operated trigger, a foot pedal, or other control input may beused. Similar control may be implemented in a hand-held tool, which mayuse a trigger or hand grip function to control the jaw position.

As the operator begins to move the jaw position control towards the jawclosed position, the reciprocating element 4 moves slightly in thedistal direction. As described above, this distal direction movementmoves the jaws from the open position to the closed position. As shownin FIG. 3, at t2 the jaw position control has been moved to command thejaws to fully close, the reciprocating element has moved slightly in thedistal direction, and the jaws move to a fully closed position in whichtissue to be sealed and cut is held between the jaws.

As also shown, at t2 the clamping force on tissue held between the jawsis shown to be substantially zero (zero). In fact, the tissue is heldbetween the jaws at a light pinching force sufficient to keep the tissuefrom sliding between the jaws. For purposes of this description, theclamping force is considered to be zero. It will be understood, however,that even at this light holding force, electrosurgical energy may beapplied to begin to fuse the tissue.

Further shown at t2, the jaw position control is not fully closed.Instead, full jaw closure is commanded when the jaw control is closed toan intermediate position, such as about eighty percent (80%) closed. Incertain implementations, reserving a small amount of jaw positioncontrol motion is a key feature that provides the operator with a smallamount of haptic feel, allows the operator to control a small amount ofadditional clamping force, or provides a safety margin that must becrossed to continue with the process. In optional implementations,however, jaw position control and jaw position are correlated so thatone hundred percent (100%) jaw position control closure is required tofully close the jaws. Details on reservation of jaw control aredescribed, for example, in U.S. patent application Ser. No. 13/655,999,entitled “Grip Force Control for Robotic Surgical Instrument EndEffector” (filed Oct. 19, 2012), which is incorporated herein byreference in its entirety.

In accordance with an aspect of the present disclosure, the operator isfree to control jaw position within the range illustrated by theconditions at t1 and t2 without concern that the reciprocating elementwill cut tissue that is between the jaws. The reciprocating element willmove distally a sufficient amount to begin to cut tissue between thejaws only when at least a second condition occurs, so that a combinationof at least two conditions is required before tissue cutting occurs, andthe second condition is more than a mere safety release condition.

At t3 the operator begins to close the jaw position control theremaining twenty percent (20%), so that at t4 the jaw position controlis fully closed. In some implementations, this further jaw positioncontrol closure has no effect on the reciprocating element position, jawposition, or clamping force. In alternative implementations, however,this small control motion moves the reciprocating element slightly moredistally, which in turn begins to apply a light clamping pressure totissue between the jaws. This situation is illustrated in dashed line at201. In implementations in which jaw position control and jaw positionare correlated, the full jaw position control closure may command eithera substantially zero clamping force or a small amount of clamping force.In accordance with an aspect of the present teachings, therefore, theoperator is still free to control jaw position within the range of beingfully open to applying a small clamping force without concern that thereciprocating element will cut tissue that is between the jaws.

In some optional implementations, the fully closed (or reaching anotherclosure threshold, such as ninety-five percent) jaw position controlcondition is required as a safety threshold before the computer controlsystem 101 will allow the reciprocating element 4 to move a sufficientdistance to begin to cut tissue between the jaws.

In various optional implementations, if at any time prior to t5 the jawposition control is moved to open the jaws, the jaws will open.

At t5, with the tissue to be sealed and cut between the jaws, theoperator gives the command to apply energy (e.g., second input 105 b ora separate input directly associated with ESU 106), which is effectivelya command to seal and cut the clamped tissue. An example of such acommand is the operator pressing or otherwise actuating an input devicesuch as a foot pedal or button (e.g., one color-coded yellow inaccordance with industry standards). As shown in FIG. 3, when the energycontrol command is received, the reciprocating element is moved to itsfull distal position so that a high force clamp is applied to tissuebetween the jaws. By the nature of the design, it can be seen that asthe high force clamp is applied, tissue between the jaws is cut. At t6the reciprocating element is at its full distal position, high forceclamp is applied to the tissue, and the tissue has been cut by thereciprocating element.

In the depicted implementation, at t6 electrosurgical energy isautomatically applied to electrodes in the jaws to fuse the tissueclamped between the jaws. The electrosurgical energy is applied untiltissue fusion is sensed (as is known in the art) at t7, at which timethe energy is removed. Consequently, at t7 the clamped tissue has beencut, and the tissue on either side of the cut has been fused.

As shown in FIG. 3, the reciprocating element remains at its distal-mostposition (the full distal position) until the energy control input isreturned to the off position. When at t8 the energy control input ismoved to the off position, the reciprocating element is automaticallymoved distally so that at t9 the reciprocating element is at a near fullproximal position, the clamp force returns to substantially zero, andthe jaws remain closed. Then, to open the jaws, at t10 the operatoropens the jaw position control, the reciprocating element moves to itsfull proximal position, and the jaws fully open, as shown at t11. Atthis position, in one implementation the system 100 is then ready toperform one or more subsequent tissue fusing and sealing operations, ortissue grasping operations, as described herein.

In addition to the illustrative implementation and the variationsdescribed above, many additional variations may be applied in otherimplementations. The options described above and below may be combinedin any way practical, as long as one or more particular option does notprevent the implementation of an embodiment with one or more otheroptions. These various options apply to both relatively largerteleoperated surgical robots designed to operate a variety of surgicaltools and to relatively smaller hand-held surgical tools designed tooperate as a dedicated single instrument type.

As described above, the cutting and fusing actions are combined with theactuation of a single input, such as a foot pedal or button.Alternatively, however, the cutting and fusing actions may be separatelycontrolled. Such separate control gives the operator the capability tocut clamped tissue without any tissue fusion taking place (a so-called“cold cut”). If tissue fusion is desired, then a second control isoperated, such as a second foot pedal or button. For example, toimplement cutting, a blue-colored foot pedal or button is pressed (e.g.,second input 105 b is provided), and to implement tissue fusion, ayellow-colored foot pedal or button is pressed (e.g., third input 105 cor an input directly associated with ESU 106 is provided). As analternative to foot pedals or buttons, various other devices may be usedto input the cut and fuse commands, such as a switch positioned near thejaw position control input, a voice command, etc. A key advantage,however, is that the input device used to control the cutting function(e.g., second input 105 b) is separate from the device used to controlthe jaw position and tissue clamping force (e.g., first input 105 a).Thus, even though a single reciprocating element is used to both actuatejaw position and carry out tissue cutting, two different input devicesare used to control these two functions. These separate inputs preventan inadvertent over-actuation of the jaw position control input, as mayoccur when a reciprocating element limit switch has been incorrectlypositioned, and unwanted tissue cutting.

In some instances the two (or more) separate inputs are combined in asingle type of input device. This single type of input device travelsover a first range of motion to command jaw position, and it travelsover a second range of motion or moves to a second position outside thefirst range of motion to control cutting. For example, the reciprocatingelement's first range of motion, which controls jaw opening and closing,may be controlled by a first range of motion of a spring-loaded pincermechanism pinched by digits of the hand. The reciprocating element'ssecond range of motion, which is associated with tissue cutting, is thencontrolled by a second range of motion of the pincer mechanism. Thissecond range of motion is separated from the first range of motion by aclear divider, such as a noticeably higher spring force, a noticeablehaptic detent, etc. Elements having two controllable ranges of motionare described, for example, in U.S. patent application Ser. No.13/655,999, entitled “Grip Force Control for Robotic Surgical InstrumentEnd Effector” (filed Oct. 19, 2012), which is incorporated herein byreference in its entirety. Similarly, a spring-loaded foot pedal mayhave two clearly divided ranges of motion, or an input may be difficultto move into a second operating position or direction (akin to a reversegear “lockout” feature in some automobile manual transmissions), or asecond mechanical input must be held in order to move the first inputinto the second range or position (akin to button that must be pressedon an automobile automatic transmission position selection lever). A keyfeature is still that while the input is operated to control jawposition, inadvertent tissue cutting is prevented, since the inputcannot move into the second range of motion or position without apositive action by the operator each time a transition to the secondrange of motion or position is desired.

Whether a single input is used to control both cutting and fusing, orwhether separate inputs are used, the required input may be continuous,such as holding a spring loaded pedal or button in an ON position, orthe input may be a brief pulse that starts the function. If the cuttingand sealing functions are combined, then a single tap of a foot pedal orbutton may be used to start the cutting and sealing process between t5and t7 as shown in dashed line at 202. Likewise, a single tap on onefoot pedal may start the cutting function and a single tap on a secondpedal may start the fusing function. Control logic prevents the fusingfunction from beginning if the second pedal is tapped before thereciprocating element is in the correct full distal position. Acombination of a tap on one input and a continuous hold on another inputmay be used. An optional warning (audio, video) may be output thatadvises the operator that the fusing function has not started. If a tapis used to control the tissue cutting function alone, then thereciprocating element may automatically return to the full- ornear-proximal position after the cutting, or a second input, such as asecond tap or the opening of the jaw position control, may be used toreturn the reciprocating element to the full- or near-proximal position.

As a safety feature, moving the jaw position control towards open (e.g.,opening the grip control) at any time during the process may stop aportion or all of the process implemented up to that time. For example,if the jaw position control is opened mid-way through the tissue cuttingfunction, the reciprocating element is returned to its full- ornear-proximal position and the jaws are moved to an open position. Theoperator then manages any bleeding or other effect of the cutting.Likewise, if the jaw position control is opened mid-way through thetissue fusing function, the electrosurgical energy is removed from theelectrodes so that the fusing function stops, and the reciprocatingelement returns to its full- or near-proximal position, eitherautomatically or as the result of another control input.

Similarly, if the combined or individual cutting and fusing functionsare controlled by a continuous input, such as a continuous foot pedal orbutton press, releasing the input may stop the cutting or fusingfunction and variously keep the reciprocating element in place orautomatically returning the reciprocating element to its full- ornear-proximal position.

In some implementations, the control system outputs an indication thatthe cut function and/or the fusing function are complete and indicatedsuccessful. In such implementations, if a situation occurs in which thecorrect conditions to carry out the cutting or the sealing function hasoccurred, but the expected indication is not output to the operator sothat the operator suspects the function was not successful, or if thesystem outputs a second indication that the expected function wasunsuccessful, various approaches may be used. Exemplary user interfacesystems providing information regarding an actual or expected outcome ofa computer-controlled surgical process are described in, for example,U.S. Patent Application Publication No. 2012/0248167, entitled “Methodsand Systems for Detecting Staple Cartridge Misfire or Failure” (filedMay 15, 2012); U.S. Patent Application Publication No. 2012/0209314,entitled “Methods and Systems for Indicating a Clamping Prediction”(filed Jan. 13, 2102); U.S. Patent Application Publication No.2012/0205419, entitled “Methods and Systems for Detecting Clamping orFiring Failure” (filed Jan. 13, 2012); and U.S. Patent ApplicationPublication No. 2012/0209288, entitled “Indicator for Knife Location ina Stapling or Vessel Sealing Instrument” (filed Jan. 13, 2012), all ofwhich are incorporated by reference herein in their entireties.

For example, if the operator suspects or receives an indication that thetissue cutting function was unsuccessful, the system may be configuredto permit the operator to attempt the cutting function again, or toprevent the operator from attempting the cutting function again, or tolimit the number of subsequent attempted cutting functions. To recoverfrom an unsuccessful cutting situation, the system may be variouslyconfigured as described above to have the reciprocating element move tothe full- or near proximal position so that the jaws can be opened.

Similarly, if the operator suspects or receives an indication that thetissue fusing function was unsuccessful, the system may be configured topermit the operator to attempt the fusing function again, or to preventthe operator from attempting the fusing function again, or to limit thenumber of subsequent attempted fusing functions. To recover from anunsuccessful fusing situation, the system may be variously configured asdescribed above to have the electrosurgical energy removed from the jawsand the reciprocating element move to the full- or near proximalposition so that the jaws can be opened.

If at any time the reciprocating element is commanded to return to afull proximal position so that tissue may be removed from the jaws, butthe full proximal position is not sensed, the control system may outputa warning to the operator that indicates that the reciprocating elementis stuck in an intermediate position. The system may be configured toattempt to recover by automatically moving the reciprocating elementdistally and then once again to move proximally in an attempt to achievethe full proximal position, or by dithering the reciprocating elementwhile urging it towards the full proximal position, or by allowing theoperator to attempt to move the reciprocating element by moving an inputdevice, such as the device used to initiate the cut function.

FIG. 4 is a diagram that illustrates an implementation of anotherprocess in accordance with an aspect of the present disclosure. Fourconditions are illustrated from top to bottom: reciprocating element(beam) position, jaw position, energy application control, and energyapplication. Jaw position control and clamp force are as described aboveand omitted for clarity.

As shown in FIG. 4, between times t1 and t2 the beam position and jawposition are related as described above. At t3, the operator initiateselectrosurgical tissue fusing energy application. This initiation isstarted by operating a second control system input (e.g., input 105 b),other than the input normally used to control jaw position during thetissue grasping function. The energy control may be held in an ONposition as shown in FIG. 4, or alternatively may be a short pulse ortap on the input, as shown in dotted line 301. For example, the operatormay press and hold a foot pedal, or the operator may tap the foot pedal.

In response to the operator initiating energy application, the controlsystem commands the ESU to apply energy to the electrodes and commandsthe actuator to move the reciprocating element towards the distal-mostposition. Thus electrosurgical tissue fusing energy is applied as thereciprocating element moves distally over the jaws. In addition, tissuecutting occurs as the tissue is fused, so that bleeding is controlled.At t4, the reciprocating element is at its full distal position, tissuefusing is complete (as indicated by the ESU), and energy is removed fromthe electrodes.

At t5 the jaws are commanded to open, either by the operator using thejaw position control input, or automatically by the control system. Asthe reciprocating element returns to its full proximal position and att6 passes the near-proximal position as described above, the jaws startto open. At t7 the beam has returned to its full proximal position andthe jaws are open.

As described herein, in some instances the control system may beconfigured to allow the operator to interrupt the fusing and cuttingaction, so that if the foot is lifted from a foot pedal, or if the jawsare commanded to open by using the jaw position control input, energyapplication is stopped and the reciprocating element is returned to theproximal or near-proximal position.

FIG. 5 is a diagram that illustrates an implementation of yet anotherprocess in accordance with an aspect of the present disclosure. Fiveconditions are illustrated from top to bottom: reciprocating element(beam) position, jaw position, energy application control, energyapplication, and tissue cutting control. Jaw position control is asdescribed above and omitted for clarity. FIG. 5 illustrates animplementation in which tissue fusing and tissue cutting are separatelycontrolled.

As shown in FIG. 5, between t1 and t2 the reciprocating element positionand jaw position are related as described above. At t2 and at t3, thetissue is lightly clamped by the reciprocating element being positionedat the near-proximal position. In some instances, this light clamping issufficient to allow effective tissue fusing, and show tissue fusingenergy application is started at t3. The reciprocating element does notmove during the energy application. At t4 the tissue fusing is completeand the energy is removed.

At t5 the operator commands the tissue cutting function to begin. Thereciprocating element moves to its distal-most position at t6. As shown,in some instances the reciprocating element moves as long as a cutcontrol input command is received. In other instances, a short pulseinitiates the tissue cutting function, as shown in dashed line at 401.From t6 to t8 the reciprocating element returns to its proximalposition, either automatically from a control system command or by theoperator commanding the jaws to open.

It can be seen that since the tissue fusing and cutting functions areseparately controlled, tissue cutting alone can be performed (the coldcutting referred to above).

Further, as described above, the separately controlled tissue fusing andcutting functions may be operated by two separate input devices, or theymay be operated by two unique and distinct control functions on the sameinput device. For example, if a single foot pedal is used to controlboth tissue fusing and cutting, a single tap or a continuous hold-downmay be used to control energy application, and a double tap may be usedto command tissue cutting (or vice-versa). It can be appreciated,therefore, that many combinations of one or more input devices (handoperated, foot operated, head operated, elbow or knee or other body partoperated, voice operated, eye gaze operated, operated by a secondperson, etc.) the or each input device providing one or more distinctranges of motions or positions, can be used to safely and separatelycontrol the grasping function versus the fusing function, the cuttingfunction, or the combined fusing and cutting function.

Further modifications and alternative embodiments will be apparent tothose of ordinary skill in the art in view of the disclosure herein. Forexample, the systems and the methods may include additional componentsor steps that were omitted from the diagrams and description for clarityof operation. Accordingly, this description is to be construed asillustrative only and is for the purpose of teaching those skilled inthe art the general manner of carrying out the present teachings. It isto be understood that the various embodiments shown and described hereinare to be taken as exemplary. Elements and materials, and arrangementsof those elements and materials, may be substituted for thoseillustrated and described herein, parts and processes may be reversed,and certain features of the present teachings may be utilizedindependently, all as would be apparent to one skilled in the art afterhaving the benefit of the description herein. Changes may be made in theelements described herein without departing from the spirit and scope ofthe present teachings and following claims.

It is to be understood that the particular examples and embodiments setforth herein are non-limiting, and modifications to structure,dimensions, materials, and methodologies may be made without departingfrom the scope of the present teachings. For example, various aspectshave been described in the context of an instrument used in a surgicalrobotic system. But these aspects may be incorporated into hand-heldinstruments as well, with powered or hand-actuated actuation of thevarious inputs.

Other embodiments in accordance with the present disclosure will beapparent to those skilled in the art from consideration of thespecification and practice of the teachings disclosed herein. It isintended that the specification and examples be considered as exemplaryonly, with a true scope and spirit being indicated by the followingclaims.

1. (canceled)
 2. A medical device comprising: an instrument comprising ashaft and a working end at a distal end portion of the shaft, theworking end comprising: a jaw mechanism moveable between an openposition and a closed position, and a translating mechanism moveable ina first direction and a second direction relative to the jaw mechanism,the first and second directions being opposite to one another; and acontroller comprising a computer processor, the controller configuredto: in response to a first input, control movement of the translatingmechanism from a proximal position to an intermediate position relativeto the jaw mechanism, in response to a second input, control movement ofthe translating mechanism from the intermediate position to a distalposition relative to the jaw mechanism, control movement of thetranslating mechanism from the distal position back to the proximalposition, and monitor a position of the translating mechanism todetermine whether or not the translating mechanism has moved from thedistal position back to the proximal position after a predetermined timeperiod.
 3. The medical device of claim 2, wherein the jaw mechanism isconfigured to move from the open position to the closed position inresponse to movement of the translating mechanism from the proximalposition to the intermediate position.
 4. The medical device of claim 2,wherein the translating mechanism comprises a cutting blade.
 5. Themedical device of claim 4, wherein the cutting blade is disposed along alength of the jaw mechanism when the cutting blade is in a position fromthe intermediate position to the distal position.
 6. The medical deviceof claim 2, further comprising a gripping mechanism or a triggermechanism, wherein actuation of the gripping mechanism or the triggermechanism causes the first input.
 7. The medical device of claim 6,further comprising a button or a foot pedal, wherein actuation of thebutton or the foot pedal causes the second input.
 8. The medical deviceof claim 2, wherein the controller is further configured to providetactile feedback to a user in response to the translating mechanismmoving from the intermediate position to the distal position.
 9. Themedical device of claim 2, wherein the controller is further configuredto output feedback if the translating mechanism is not in the proximalposition after the predetermined time period.
 10. The medical device ofclaim 2, wherein the controller is further configured to controlmovement of the translating mechanism to cause the translating mechanismto move reciprocally in the first and second directions if thetranslating mechanism is not in the proximal position after thepredetermined time period.
 11. The medical device of claim 2, whereinthe controller is further configured to control movement of thetranslating mechanism to cause the translating mechanism to dither ifthe translating mechanism is not in the proximal position after thepredetermined time period.
 12. The medical device of claim 2, whereinthe working end comprises a stapling mechanism.
 13. A method ofcontrolling a medical instrument, the method comprising: in response toa first input, causing movement of a translating mechanism from aproximal position to an intermediate position along a jaw mechanism ofthe medical instrument, wherein the movement of the translatingmechanism from the proximal position to the intermediate position movesthe jaw mechanism from an open position to a closed position, wherein aproximal portion of the jaw mechanism is coupled to a shaft of themedical instrument; in response to a second input, causing movement ofthe translating mechanism from the intermediate position to a distalposition along the jaw mechanism; causing movement of the translatingmechanism from the distal position back to the proximal position; andmonitoring whether or not the translating mechanism has moved from thedistal position back to the proximal position after a predetermined timeperiod.
 14. The method of claim 13, further comprising performing acutting function with the translating mechanism when the translatingmechanism moves from the intermediate position to the distal position.15. The method of claim 13, further comprising receiving the first inputin response to actuation of a gripping mechanism or a trigger mechanism.16. The method of claim 15, further comprising receiving the secondinput from actuation of a button or a foot pedal.
 17. The method ofclaim 13, further comprising providing tactile feedback to a user inresponse to the movement of the translating mechanism from theintermediate position to the distal position.
 18. The method of claim13, further comprising outputting feedback in response to determining,from the monitoring, that the translating mechanism has not moved backto the proximal position after the predetermined time period.
 19. Themethod of claim 13, further comprising moving the translating mechanismreciprocally in response to determining, from the monitoring, that thetranslating mechanism has not moved back to the proximal position afterthe predetermined time period.
 20. The method of claim 13, furthercomprising dithering the translating mechanism in response todetermining, from the monitoring, that the translating mechanism has notmoved back to the proximal position after the predetermined time period.21. The method of claim 13, further comprising performing a staplingfunction using the working end.
 22. The method of claim 13, furthercomprising performing a fusing function using the jaw mechanism.
 23. Themethod of claim 22, wherein: the jaw mechanism performs the fusingfunction in response to a third input, the first input being received inresponse to actuation of a first input device, the second input and thethird input being received in response to actuation of a second inputdevice, and the first input device is different from the second inputdevice.
 24. The method of claim 22, wherein: the jaw mechanism performsthe fusing function in response to a third input, the first input isreceived in response to actuation of a first input device, the secondinput is received in response to actuation of a second input device, thethird input is received in response to actuation of a third inputdevice, and the first input device, the second input device, and thethird input device being different devices.